Objectives – Define panic – Examine how the fight or flight reaction can be corrupted to prompt panic attacks – Examine the cognitive, emotional, behavioral, biological sources of the stress reaction – Explore a variety of interventions that may assist people in counterconditioning the panic response

Why I Care/How It Impacts Recovery – Panic attacks can feel overwhelming – Panic attacks are exhausting and can leave people feeling out of control of their own body – People can avoid things they have phobias of, but panic attacks seem to come out of the clear blue – People with panic attacks often restrict what they do (superstitiously) to avoid panic triggers – Awareness of what a panic attack is and what triggers them for each individual is crucial to recovery.

The Body's Response to Anxiety/Panic – We have a primitive response system that protects us from danger “Fight-Flight-Freeze” – To prepare to take on the threat, the body sends out “excitatory” signals – Increase in heartrate – Increase in respiration – Numbness or tingling in hands (blood to the core) – Sweating (temperature and slipperiness) – Pupil Dilation (blurred vision/spots/brightness) – Muscle Tension The Mind's Response to Panic – Oh CRAP! – Something bad is going to happen or I wouldn't be feeling this way – Catastrophic thinking— I'm going to – Pass out – Die – Throw up – — The Panic Cycle Track Panic Symptoms: Anxiety Log – Log your anxiety episodes (not just panic) – What were your symptoms – Physical – Cognitive – Emotional – What triggered it – Why did that trigger it – What may have made you more vulnerable to your triggers Life Through Panic Colored Glasses – If you are hypervigilant about panic triggers, you will find them – Review your Anxiety Log – Identify your triggers – Make a plan to deal with them – Identify vulnerabilities – Make a plan to prevent them Body Awareness | Physical Mindfulness – Body Scan – What am I experiencing – What might be causing it – Blood Sugar – Stimulants – Adrenaline Rush – Orthostatic Hypotension – Excitement or Panic Its only a False Alarm – Mindfully attending to panic – Feel the sensations – Focus on breathing – Use positive self-talk

– Activity – For each of the above, identify – What causes the emotion, or what the emotion means about you – Dispute it Stress and Time Management – You can feel time-stressed because – You are over committed – You procrastinated – Sometimes procrastination is caused by anxiety (Philosophy 101) – Activity – Make a list of all the things you have to do (I use index cards) – Separate the lists into 3 categories: Must do, Need to do soon, Like to do – Prioritize and delegate the must dos

Apply It – Identify 3 ways you could have used this information in the past week. – What was the situation- – What did you do- – How effective was that for you- – Short term – Long Term – If you would have had this new information, what could you have done differently- – How would that have changed the outcome- – How can you start integrating this knowledge into your routine Summary – Panic is caused by the fight or flight reaction – Many things (mostly benign) may cause symptoms of the stress reaction – Cognitive interpretations of these symptoms can cause a full blown panic attack. – Body scan and breath awareness help some people – RAIN and Distraction may work better for others – Eliminating vulnerabilities can also eliminate low-grade chronic stress which can increase the likelihood of a panic attack.

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